POS1182 GENDER IMPACT ON BASELINE PRESENTATION AND OUTCOME IN ADULT IGA VASCULITIS
Authors: K. L. Baud, Y. Ramdani, V. Maisons, E. Pillebout, J. F. Augusto, N. Jourde-Chiche, S. Faguer, N. Ferreira-Maldent, F. Maillot, B. Terrier, A. Audemard
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> It has been shown that patient's demographical characteristics may impact presentation and outcome in adult IgA vasculitis (IgAV). Aging was shown to negatively impact disease severity and outcome of adult IgAV. IgAV is also known to be more frequent in male, with a male to female gender ratio of 1.6. However, the potential impact of gender during vasculitis has been overlooked. <h3>Objectives</h3> We aimed to study the impact of gender on presentation and outcome of adult IgAV. <h3>Methods</h3> We retrospectively study the data of the French retrospective multicenter cohort (IGAVAS), including 260 IgAV adult patients. Comparison of presentation and outcome were performed according to gender status (male <i>vs</i>. female). <h3>Results</h3> Of the 260 patients included, data from 259 patients were analyzed: 95 female and 164 male (one missing data). Compared to female, baseline disease presentation in male was similar for cutaneous involvement (n=164 (100%) <i>vs.</i> n=95 (100%), p= 1.0), joint (n= 99/164 (60%) vs. n= 60/95 (63%), p= 0.7) involvement, gastrointestinal involvement (n= 93/164 (57%) <i>vs.</i> 43/95 (45%) p=0.093) and glomerulonephritis (n=120/164 (73%) <i>vs.</i> n=61/95 (64%) p=0.16)). However, compared to female, glomerulonephritis in male was more severe at baseline with lower glomerular filtration rate (median (IQR) 90 ml/min/1,73m2 (59-105) <i>vs.</i> 97 ml/min/1,73m2 (76-116), p = 0.015)), increased protein level excretion (0.84 g/day vs 0.58 g/day, <i>p</i> = 0.01) and a higher serum IgA level (3.6 g/l (2.5-4.8) <i>vs.</i> 3.3 g/l (2.3-4.6) p=0.03). However, among patients who had renal biopsy (n =47 female, n=97 male), no significant difference was observed. Male were more frequently and more aggressively treated than female. Pulses of methylprednisolone were more frequently prescribed in male (n=52/129 (40%) <i>vs.</i> n=14/64 (22%), p= 0.015). Immunosuppressants were more frequently given to male, especially cyclophosphamide (n=31/129 (24%) <i>vs</i>. n=4/64 (6%), p=0.0025) and azathioprine (10 % <i>vs</i> 2%, <i>p</i> = 0.038). Analysis of treatment response showed that male had more frequent refractory disease: lack of response was significantly higher in male compared to female (30 % <i>vs.</i> 13%, <i>p</i> = 0.004). Finally, baseline differences did not impact long term outcome such as mortality (7 % in male <i>vs.</i> 5 % in female, <i>p</i> = 0.77), neither progression to chronic kidney failure, dialysis transplantation. <h3>Discussion</h3> Interpretation of this study is tricky. There is a discrepancy between renal laboratory and pathological findings making difficult to affirm a greater severity of glomerulonephritis in male. Additionally or renal. data regarding comorbidities influencing renal function has not been gathered. However, in the literature, studies have shown differences between male and female in IgA nephropathy with more rapid progressive disease in male population. Moreover, a Slovenian group recently observed in a prospective cohort of 124 adults IgAV patients, that males had more severe disease than females. <h3>Conclusion</h3> Despite its limits, this study raises the question of a more severe disease in male in terms of glomerulonephritis. This hypothesis is sustained by the fact that male compared to female were strikingly more severely treated and present a poor short outcome whereas the long term outcome do not seem to differ. Altogether, these results raise the question of the gender as a new prognostic factor during the course adult IgAV. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.